Paradichlorobenzene (toxin)-induced leucoencephalopathy

Abstract

A 40-year-old woman with a history of polysubstance abuse, hypertension, depression and anxiety with panic attacks admitted to the emergency room at the request of her primary physician owing to progressive decline in her mental status associated with anorexia and generalised pruritic skin rashes. Initial outpatient workup and that during two previous hospital admissions including thyroid function and syphilis tests, urine toxicology screen and brain imaging studies were unremarkable. Repeat MRI of the brain during her third hospital admission showed diffuse periventricular and white matter disease. This prompted further questioning of family members which revealed chronic ingestion of mothballs and toilet cakes containing paradichlorobenzene in the patient leading to toxin-induced leucoencephalopathy consistent with her neurological symptoms of altered mental status, ataxic gait, cogwheel rigidity in the arms and characteristic skin rashes. Subsequently, a feeding tube was placed to address her worsening nutritional status and she was discharged home in a stable state.

Figure 1

Hyperpigmented pruritic skin rashes.

Figure 2

MRI of the brain without contrast. Findings of extensive diffuse T2-hyperintense signal abnormality involving the periventricular and deep white matter of cerebral hemispheres, corpus callosum, white matter tracts of cerebellum, middle cerebellar peduncles, posterior pons and cerebral peduncles.